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Becker’s Healthcare Podcast
Expanding Trauma Informed Mental Healthcare for Mothers, Infants, and Families with Dr. Obianuju Berry
00:16:11
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- [00:00]
A
My name is Rosie Talaga with the Beckers Healthcare podcast. I'm thrilled today to be joined by Dr. Uju Berry, Medical Director of NYC Health and Hospital's Maternal, Infant and Domestic Violence mental health services. Dr. Berry, it's a pleasure to have you on the podcast today.
- [00:17]
B
Oh, thank you so much, Rosie. I'm happy to be here.
- [00:19]
A
We have a great conversation in store, looking at the opportunities and headwinds that are making an impact right now and looking ahead to how these might shift in the future. Before we get into it, Dr. Barry, can you please take a minute to introduce yourself and tell us a bit about your background?
- [00:34]
B
Absolutely. So, hi everyone. So, as mentioned, I'm Dr. Berry, so I am serving as the new inaugural role of New York City Health and Hospital's Maternal, Infant and domestic Violence Mental Health Services. Honestly, this expanded role really just encapsulates all my many years of training, 15 plus years of training as a child psychiatrist, reproductive psychiatrist, trauma expert and researcher who does a lot of work bridging the gap between maternal, infant health and behavioral health and reducing any types of morbidities from trauma. So in this new expanded role, I'll be able to support system wide initiatives at New York City health and hospitals to strengthen mental health care for pregnant and postpartum individuals as well as their infants. In addition to kind of continuing my services, working closely with the city to bring in mental health, access to our DV domestic violence shelter systems and New York City Family justice centers as well. And I also, as an aside, do teach some classes, see patients, teach some classes at NYU where I'm an associate professor, and then serve as medical director and principal investigator on two national grants. One is a Healthy Brain Child Development study and the other one is a SAMHSA funded National Child Traumatic Stress Network project. So keep my hands busy, keep myself busy, but really excited to be in this role and to really support our New Yorkers.
- [01:58]
A
Thank you so much. Yes, you do seem like you're keeping busy. Great, great experience. 15 plus years. And I'm really looking forward to learning more about everything you've learned along the way. So to start us off, we know we're in such a formative time and wrapping up the year in just a couple weeks as we're looking ahead to 2020 opportunities and headwinds. Do you have your eye on right now?
- [02:23]
B
Yeah, absolutely. So I am, you know, it's really as we close at 2025, a lot has happened in 2025 and I'd be remiss to not talk about some or at least mention some of those challenges that many of our patients and our clients face in terms of just decreased access to mental health care. But I am really hopeful for 2026 and what that brings. I'm optimistic about the shift towards more integrated community centered care, which is where the bulk of my programs really rely on really just breaking down silos across systems, across agencies, across disciplines. Really treat our New Yorkers who are impacted by behavioral health or other types of traumatic events. And we see this with signals that are happening from New York State Office of Mental Health where there's just been this real big push, push towards collaborative care models and really integrated care to really think holistically about maternal care, infant care and trauma and trauma informed services. And so really thinking about riding this momentum and navigating some of those headwinds as we, as you articulated, to kind of ride the wave despite what's happened, really kind of learning from what those gaps are. In particular, some of the areas I'm interested in is really thinking about our staffing and retention for these type of services. Really trying to invest the money in the workforce to be able to work with, be able to provide high quality clinical care to our, to our New Yorkers. So New York City Health and Hospital serves over a million New Yorkers a year. And people come from all walks of life. And so how can we take care of them? And that's really by supporting our workforce and supporting our staff to do so. And then also really thinking about taking a really deeper eye into some of those disparities that we're seeing in maternal mortality and trauma informed care and really addressing some of those structural barriers and really thinking about how can we decrease those rates of maternal mortality and morbidity and really supporting our survivors as much as possible who are asking for help, who want the help, and how we can really kind of push New York City health and hospitals to be the bread and butter of those million New Yorkers and more who come into our city.
- [04:41]
A
Absolutely. I think that's super refreshing to hear your optimist take, regardless of, like you said, the different challenges and decreased access to mental health care that's gone on this year, but really like you said, riding the momentum and riding that wave of the headwinds despite what's happened and moving forward. It's really refreshing to hear.
- [05:01]
B
Yeah, I'm a glass apple person.
- [05:03]
A
That's wonderful. We need more of those people. I think something that goes hand in hand with looking ahead and moving forward is discussing growth. So I'd like to Ask, how are you thinking about growth and adding value to your organization?
- [05:19]
B
You know, I think that's such a great question to ask because, you know, whenever you're in the work of public health, you always got to think about growth and adding value, and particularly making sure that the work you're doing is serving the population that you're trying to serve. And if not, then you need to grow and add more value. So those two components are so crucial to how I think about the work I do. And so when I think about the growth, a lot of times people think about it as scaling up. You might have heard the term scaling up, and that's absolutely true. So right now we want to, we have the work in these shelter services and in the FJCs, but are we missing other people? So we want to scale up and I'll talk a little bit more about that. In addition, while you're scaling up, we also don't want to lose sight of value and the quality of work. And so I also view this as deepening the quality of the specialized care I do bring to vulnerable populations. So for the first part, growth really, it's really expanding the reach of specialized care using this model that my team has created called the Siren model, which really stands for universal screening, identification, increased referrals and education. In particular, this model can be applied anywhere. And what we're doing right now is we're applying this model to thinking about integrating early childhood mental health into non traditional settings. We've already been able to establish that by introducing mental health services into non traditional settings. So my work in the domestic violence shelters, as in the 41 domestic violence shelters that were in and in the five family justice centers, was the first time in the country that a city had taken a systemic approach to meeting families where they feel safe. So instead of having families come into the hospitals, which is usually how we think about mental health care, medical care is being served. Our team actually goes directly to the families in those advocacy centers and in the shelters that they're in, making sure that when they feel safe physically, we also make sure that they feel safe mentally. But what we noticed when we were there is that many of the services were geared towards adults, which is great. We want to make sure the adults are being taken care of. But what we did realize is that many of those adults were coming into care because they also wanted help for their children, and particularly that very vulnerable, very young children, the 0 to 5 age group. And so we kind of pivoted. We really went from adult centered model to thinking about a family centered model and really integrating early childhood mental health into these non traditional settings. And so what I hope to do is grow and scale this model of thinking about taking care of these again, screening, identification, referrals and education into non traditional settings and really thinking about system change when we do that. So that's number one. But number two again, how do we grow without actually not serving those families and really think about sustainability and really thinking about the quality of work. And so what we want to do is really strengthen those interagency collaborations. Again, when you're going into a non traditional medical, medical setting, there are agencies that may speak a different language than we do. And so how do we invest in communication, how do we strengthen those relationships and how do we empower people in those arenas to be able to really think about providing the best care to those who are in those settings. But ultimately the greatest value that we can actually provide is just breaking the cycle of intergenerational trauma and by intervening early and really thinking about prevention and really thinking about family care to hopefully change long term health trajectory for all our families in New York.
- [08:59]
A
Those are great, great insights. I think a common theme with what you're saying is meeting the patients where they are, whether that be ensuring they're physically and mentally safe by meeting them at their advocacy centers or their shelters, but then also meeting those places that you're meeting at the advocacy. Like you said, they might have different languages meeting them where they're at as well with that common communication to really be able to work with them and provide the needs that the community is in need of.
- [09:31]
B
You're absolutely right, Rosie. That was such a nice synthesis of what I just said. So absolutely right.
- [09:38]
A
So looking ahead, I think we're living in such a transformative, fast paced world which can be very beneficial and exciting. But sometimes the hardest part of change is figuring out what change to make. So I would love to hear your take on what you think a risk or investment that's worth making this year.
- [09:58]
B
Absolutely. So I think those, those two points go hand in hand. So whenever there's risk, we also need to think about there's a gap. And so we definitely need to invest in making sure that gap no longer exists. And that risk or that gap that we're thinking about is investing heavily in specialized mental health care that's co located in a non traditional setting and really thinking about the very young children that are in need who are in these spaces who rely so heavily on adults in their arena. And historically the risk was Perceived as that if you're focusing so much on the young, you may not be able to see the results. But what we do know is that for every dollar that is spent, invested in early childhood mental health, we do see return of up to $13 in long term savings care. In addition, there's a risk of not doing anything. There's a cost of silence that happens when we go, when we leave these early children, young children to be neglected somewhere upwards of these children who get neglected, they become adults. And these adults who do are not investing charterly in their education. Their behavioral health can lead to cumulative costs in the society, leading to loss productivity, leading to losses of wages, leading to more types of money that's put in the very tail end as opposed to putting in the money now. And so the investment is really just thinking about prevention and early prevention as much as possible. And again, thinking about the siren model. How can we do universal screening so it's not just a squeaky wheel gets the grease, but everyone gets identified early on and gets targeted treatment that really helps them and referrals to cases that really make areas that really support their needs. And then really kind of educating the public around the value of these type of interventions and ultimately really thinking about creating a system that we can find target the early children in the areas where, as you mentioned, where they feel safe and where they are bringing the values, bringing the care to where people are.
- [12:04]
A
Absolutely. That's a great, great call out that the investment worth making is for prevention and specifically early prevention, which goes back to what you said earlier about how traditional models were more adult centered. And now it's moving to. Are you trying to make it move more towards family centered models which is really important to focus on the youth because one day the youth will be the adults that you'll maybe not have to spend the resources and time on. If they got what they need when they were younger, that's great.
- [12:33]
B
Yeah, 100%.
- [12:36]
A
So for our last question I'd like to hear about dive in a little deeper to the predictions for the future. Whether you're thinking more short term or long term. Where do you see the best opportunities for growth in the future?
- [12:50]
B
Yeah, so I think the two areas I see the best opportunities for growth is really shifting, as I mentioned, shifting this model of being reactive so to being preventive. So instead of waiting for our adults to get sick, why don't we treat the kids for when they're young? We know about the earliest signs of anxiety and depression actually starts in adolescence. And so maybe we can start there. Sometimes we can even start earlier on, like so during infancy and toddlerhood. And in fact, actually some of my research showing that pregnant women who actually feel stress themselves can actually impart some of that stress to the babies in utero. And so again, that's another preventive measure. So starting early on, so shifting the dial to start early. And I think that's a great opportunity because again, we put invest those dollars in now, then we'll be able to have a bigger risk return on our investment later on. And the second area of growth is really thinking about non traditional settings. There's so much research that's going on right now where we see people want, people want care, it's hard for them to access care. And when you think about particular areas where there are food deserts or they're, you know, hospital deserts, you know, maybe like coming to the hospital is not the best answer for people. We also need to think about the cost of them traveling for so long, like here in New York City, you know, sometimes you could be on the subway for hours just to get to an appointment and that's lost time in your wages. And so just as we learned how telehealth can be so advantageous to those families, we can also think about shifting the dial from the medical model to thinking about it being in the community. And so this, the idea is to really kind of grow our future to becoming like a seamless safety net where our city can actually support everyone no matter where they are and where they can get care. To be able to prevent care, prevent the violence, the ongoing sequelae or consequences of any social determinants of health, but also apply them to the communities where people are at already.
- [15:03]
A
Those are great takeaways. I think those two examples of the opportunities in the future, one, that shifting model of from being reactive to preventative. I loved your quote of saying don't wait for adults to get sick, treat kids when they're young, even very interesting about the feelings of stress possibly being passed on even during pregnancy. And then the non traditional settings, again, people want care, it's hard for them to access care. And just because what's best for one person or population, that doesn't mean it's universal. Going back to your, your statement of saying you work in public health, you need to serve the population that you're trying to serve, it's different for everyone. So that's really, really inspiring. Thank you.
- [15:50]
B
Thank you.
- [15:52]
A
That is the end of our discussion today. Thank you so much, Dr. Ujuberi. It's been a pleasure talking with you and hearing about all the amazing things you're doing at NYC health and hospitals, and we hope to collaborate with you again soon.
- [16:07]
B
Oh, I look forward to that, Rosie.